This report presents the results of a study of alcohol testing
and reporting methods and rates for drivers involved in fatal traffic crashes.
It identifies the best practices currently in use and the major barriers to
increasing testing, as determined from detailed studies of ten States. It concludes
with suggestions for implementing these best practices.

BACKGROUND

The National Highway Traffic Safety Administration (NHTSA) estimates that
more than one-quarter of all drivers in fatal crashes in 2002 had a positive
Blood Alcohol Concentration (BAC), and 21 percent had a BAC level at or above
the typical per se limit of 0.08. Accurate State and national data are critical
to measure the size of this impaired driving problem, describe its characteristics,
evaluate trends, explore potential countermeasures, and evaluate the effects
of laws and programs.

The most accurate data come from a blood or breath measurement of a driver’s
BAC. In 2002, NHTSA’s Fatality Analysis Reporting System (FARS) annual
report data file recorded BACs for 65 percent of fatally injured drivers, 25
percent of surviving drivers, and 43 percent of all drivers in fatal crashes.

STUDY GOALS AND ACTIVITIES

This study’s goals were to identify the best practices for, and the
barriers and problems that hinder, obtaining BAC data for drivers involved
in fatal traffic crashes, and to provide recommendations for States that wish
to improve their BAC testing and reporting. The study reviewed each State’s
laws affecting BAC testing, recent testing rates, and other information on
each State’s practices and results. With the advice of a steering committee
representing the organizations and disciplines involved in BAC testing and
reporting, ten diverse States were chosen for detailed examination. Known BAC
rates in 2001 ranged from 89 percent to 45 percent for fatally injured drivers,
and from 83 percent to 1 percent for surviving drivers, across the ten States.
Through personal and telephone interviews, project staff examined in detail
each State’s BAC laws, policies, practices, procedures, and testing results.

STATE LAWS REGARDING BAC TESTING IN FATAL CRASHES

Fatally Injured Drivers

Mandatory testing: 25 States require a test.

Discretionary testing: 11 States authorize, but do not require a test.

No law: 14 States and the District of Columbia.

State
law type

2002
State BAC Testing Rates

Lowest
State's rate

Median
State's rate

Highest
State's rate

Mandatory test

43 %

82 %

91 %

Discretionary test

37 %

70 %

83 %

No law

16 %

80 %

98 %

Testing rates varied widely for States with each law type. A mandatory law
by itself does not guarantee a high testing rate, and high rates can be obtained
under each type of law.

State medical examiners in many States or jurisdictions have adopted the practice
of conducting a BAC test on every traffic fatality so that the medical examiner’s
report can assess whether alcohol may have affected the death. Each of the
ten study States had a mandatory testing law or medical examiner practice of
testing all traffic fatalities. The two States with less than 80 percent known
BACs had not implemented the law or practice in all areas of the State.

Surviving Drivers

Mandatory testing: 5 States require or permit a test for all surviving
drivers.

Discretionary testing: 5 States reduce the standard required for a test,
usually allowing a test when the driver is believed to have caused the crash.

Required to submit to a test request: 30 States and the District of Columbia
make test submission mandatory when the implied consent provisions have been
met.

No law: 9 States do not distinguish surviving drivers in fatal crashes
from other drivers.

The five mandatory test law States had by far the highest testing rates, followed
by States with no special law. At least one State in each law category (with
the exception of the statistical purposes law) tested more than 70 percent
of the surviving drivers.

State law type

2002
State BAC Testing Rates

Lowest
State’s rate

Median
State’s rate

Highest
State’s rate

Mandatory test

47 %

79 %

90 %

Reduced standard

9 %

22 %

76 %

Required if DWI

4 %

32 %

74 %

Statistical purposes

22 %

No law

1 %

33 %

72 %

Some law enforcement jurisdictions request voluntary tests from all surviving
drivers not suspected of Driving While Impaired (DWI), as well as requesting
tests of the remaining drivers under standard DWI procedures. Most drivers
comply with this request. Many traffic fatalities in some States are investigated
by dedicated teams or by Highway Patrol/State Police officers, who have the
training and incentive to achieve high testing rates.

State Insurance Laws and Regulations
Many emergency treatment facilities draw blood from trauma patients for clinical
purposes. This clinical blood sample may be the only source of a useful BAC
test result. Until recently, the Uniform Accident and Sickness Policy of
the National Association of Insurance Commissioners (NAIC) had a provision
that allowed insurers to deny payment for medical treatment of intoxicated
persons. More than 30 States adopted this provision, which substantially
impedes BAC testing and reporting in some States. NAIC repealed this provision
in 2001, but many States have not yet eliminated it from their laws or insurance
codes.

BAC TESTING AND REPORTING PROCESSES

Three fundamentally different circumstances occur in obtaining a BAC from
a driver in a fatal crash. When the driver dies at the crash scene, the coroner
or medical examiner is responsible for investigating the death and obtaining
any BAC information. Some medical examiners and coroners may not choose to
draw a blood sample and some may not have appropriate equipment or training.
Laboratories may have no standard procedure for reporting BAC results and reports
may be delayed for many months.

When the driver is transported to an Emergency Department (ED) for treatment,
the investigating law enforcement officer is responsible for requesting a blood
sample in a timely manner from the facility or a BAC value from the facility’s
analysis of a blood sample. Law enforcement must first establish that the driver
meets the State’s requirements for a test. Medical facilities may require
a warrant before drawing a blood sample and may be reluctant to draw a sample
if insurance companies may not pay treatment costs for intoxicated drivers.

When the driver remains at the crash scene, the investigating law enforcement
officer is responsible for determining if a BAC test is allowed under the State’s
laws and then administering a breath test or transporting the driver to a person
authorized to draw a blood sample.

No one model BAC testing and reporting system applies to all States. The
following best practices are presented both as general principles that each
State can apply within its own structure and as examples from the study States
that other States may wish to adopt or adapt.

Who is tested: fatally injured
drivers

Conclusions

Best practices

Mandatory testing laws for driver fatalities produce high testing
rates only if the laws are understood and followed consistently. Mandatory
testing laws by themselves do not assure high testing rates.

A medical examiner or coroner practice of testing all driver fatalities
will produce high testing rates if understood and followed consistently.

Establish and follow medical examiner and coroner practice of testing
all driver fatalities.

In States with mandatory testing laws, inform all coroners and medical
examiners of the law’s requirements and assure that these requirements
are followed.

Provide medical examiners and coroners with appropriate training
and equipment.

Who is tested: surviving drivers

Conclusions

Best practices

Mandatory testing laws for surviving drivers produce high testing
rates, but only five States have these laws.

Without either a mandatory testing law or a voluntary testing program,
test rates are unlikely to exceed 35 percent and may be considerably
lower.

Rural areas may have lower testing rates for both fatally injured
and surviving drivers due to lack of knowledge by coroners or medical
examiners, lack of equipment or training, or long travel times to medical
facilities or breath testing equipment.

In States with no mandatory testing law, request voluntary tests
for all surviving drivers in fatal crashes.

Establish standard procedures to request and administer tests.

Provide appropriate training and equipment for all law enforcement
personnel or others who administer tests.

Management is a continuing challenge, in part because organizations
with critical roles are housed in several State agencies.

Funding and resources can be barriers.

Several States have used BAC testing and reporting forums to improve
their rates substantially.

Maintain good communications and relations among all organizations
and staff involved in BAC testing and reporting.

Maintain good communications and relations with counterparts in adjoining
States to obtain crash and medical facility reports from these States

Maintain adequate staff levels in all involved organizations, especially
the State FARS office.

Conduct State or regional BAC testing forums as appropriate.

IMPLEMENTATION

States have primary responsibility for BAC testing and reporting and for implementing
the best practices discussed in this report. Each State should consider its
own BAC testing and reporting rates and processes. If improvements are sought,
each State should implement the strategies and best practices that are most
appropriate to its situation. Other organizations can and should assist States
through activities including the following.

National Highway Traffic Safety Administration (NHTSA)

Establish national guidelines for testing and reporting rates, for example
80 percent known BACs for fatally injured drivers (achieved in 2002 by 21
States) and 60 percent for surviving drivers (eight States), as were used
in the Section 410 grant criteria.

Accept PBT and other non-evidentiary BAC evidence in FARS for drivers where
evidentiary BAC tests are not available or appropriate.

Assist States to improve BAC testing and reporting:

Organize and fund regional BAC or FARS meetings;

Help States organize and fund State BAC forums;

Support, recognize, and reward State FARS management and staff.

Governors Highway Safety Association (GHSA)

Help establish BAC testing and reporting as a priority for States, through
a resolution (adopted at the 2003 GHSA Annual Meeting).

National Association of Medical Examiners (NAME)

Establish a best practice for medical examiners and coroners of BAC testing
every driver fatality; encourage medical examiners and coroners to follow
this best practice.

Work with NHTSA to develop and implement training for coroners, medical
examiners, and others who may participate in BAC testing of fatally injured
drivers.
International Association of Chiefs of Police (IACP), National Sheriffs’Association
(NSA)

Support voluntary BAC testing for all surviving drivers in fatal crashes
through national resolutions, State and local policies, and training as needed.

National District Attorneys Association (NDAA)

Support voluntary BAC testing for all surviving drivers in fatal crashes
through national resolutions and State and local policies.

All Organizations

Support States in eliminating provisions from State laws or insurance codes
that allow insurers to deny payment for treating intoxicated persons.

Support the training and equipment that law enforcement officers, medical
examiners, and coroners need for BAC testing and reporting.

PREPARED FOR THE DEPARTMENT OF TRANSPORTATION, NATIONAL HIGHWAY
TRAFFIC SAFETY ADMINISTRATION, UNDER CONTRACT NO: DTNH22-98-D-45079. THE OPINIONS,
FINDINGS, AND CONCLUSIONS EXPRESSED IN THIS PUBLICATION ARE THOSE OF THE AUTHORS
AND NOT NECESSARILY THOSE OF THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION.